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Immunization Administration: New Codes Effective Jan. 1, 2011

Dec. 24, 2010

As of Jan. 1, 2011, two new Current Procedural Terminology (CPT®) codes for the administration of immunizations will become effective. The code descriptions are as follows:

90460

Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component

+90461

Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component (list separately in addition to code for primary procedure)

BCBSIL will recognize these newly adopted CPT codes as of Jan. 1, 2011. The initial vaccine administration will be reimbursed at the full allowance. A multiple vaccine administration reduction will be applied on subsequent initial vaccine/toxoid components and each additional vaccine/toxoid component provided on the same date of service. The multiple vaccine reduction is consistent with BCBSIL’s current reimbursement methodology.

Please note that, due to the short time frame between notification of these new codes and their effective date, BCBSIL continues to work on system enhancements to administer this multiple vaccine administration reduction. With this in mind, please be advised that BCBSIL will perform periodic claim reviews to determine if any claims have been overpaid. BCBSIL may request refunds when such overpayments are identified. 

Current Procedural Terminology (CPT® ), copyright 2008, by the American Medical Association (AMA). CPT is a registered trademark of the AMA.